NOTHING BUT THE TOOTH: When dental insurance plays a role

Thursday

Feb 8, 2018 at 8:44 AM

By Dr. Richard Greenberg

Q. Hello Doctor Greenberg, I am a dentist and want to offer my congratulations and support for your new newspaper column. I am always in favor of educating the public, and increasing awareness of the importance of good dental health. My question is regarding dental insurance. How is it, when the cost of everything (office supplies, equipment, staff salaries, utilities, etc.) have increased vastly over the last 25 years, that dental insurance benefits are exactly the same? A maximum annual benefit of $1,500 to $2,000 doesn't go very far these days. Compared to medical benefits, insurance companies seem to ignore the economic realities of modern dentistry.

A. The answer is simply, insurance companies do it BECAUSE THEY CAN.

Patients need to understand that most dentists are small-business operators. They are really no different than other skilled service providers like electricians, plumbers and the like. It is only that the service we provide is health-related. We set up a "private" practice where we invest in a facility, buy the equipment and supplies, employ the support personnel and take on all the obligation and risk. We the dentists have to assign a fee for our services and this is usually determined by what is customary for the area we chose to practice in. It is the patient that needs to evaluate the service we provide and determine if the fee is fair. If so, we move ahead in our relationship and hopefully it continues to blossom for years to come.

In the 1960s and 1970s when I set up my small business, dental insurance was very uncommon. Dental fees were reasonably stable. Medical fees began to rise and patients became concerned with the unknown fees that might be thrust upon them. Insurance companies recognized this as a fertile market. We all know what happened then in that medical insurance became a given. I believe that physicians and hospitals were thinking that they would provide treatment and insurance companies would reimburse their fees. They quickly found that, desired or not, they now had a partner and insurance companies began to control fees and subsequently even treatment.

Not long after, the insurance companies decided to include dental coverage in the packages they marketed. The only problem was that they did not control dental fees as they were doing in medicine, so they had to put a cap on what a patient could receive in one calendar year. This limited their exposure and gave a more predictable outcome for their business model. They were in business to make a profit and not incur a loss. Calendar year amounts that they would pay ranged from $500 to even $2,000 depending on what the employer or even individual was willing to pay.

Subsequently, to further try and control our small businesses and the fees we charge, they came up with the term "reasonable and customary." They decided what our fees should be and patients quickly became confused. It was easy to point to the dentist whose fee was not in that range as the problem. I had to point out to my patients that this was my small business and only I could determine what the fee should be. In my case, patients understood and our business model was upheld. I treated them, they paid for the service and any monies due them from insurance went directly to them.

Medical treatment and payment became very different in that many physicians began to accept what insurance paid as payment in full, as did hospitals. For whatever reason, they did not stand firm and accepted this new business model.

Patients need to understand that we dentists choose not to work for the insurance company. The reasons are obvious. We chose a profession where we could work for ourselves and our success or failure was in our control. I believe all can easily understand why this "work for yourself model" was preferred.

Currently dentistry and patients are seeing growth of a larger business model. This model is on a much-bigger scale where dental professionals are being employed by larger groups. What these dentists are now seeing is that when you are employed, your decision-making can be influenced by those who are in control. The employers may be more interested in the profit objective and not so much in the professional and ethical objective. Patients who are unaware may be and have been led astray where they are no longer seen as human beings with specific needs and desires but rather as ones to be taken advantage.

It is for you the patient to decide what model suits you best. In the small model I and many other dentists prefer, you the patient are the focus of attention and need to be satisfied. Insurance may be there to help, but you are the decision-maker. When you the patient are no longer shouldering the financial responsibility, you might and often do lose control. You might assume that "the doctor knows best," but sadly this is sometimes not the case. The doctor’s objectives might be turned away from the professional for whatever the reason. It may not even be that they are being employed but that they are human beings and somehow deviated from the ethical path.

If you the patient give up financial responsibility, then you give up control of your health, in this case dental health, and may be subject to abuses in that area. Please understand that professional and ethical care can be provided by any dental professional, whether they work for themselves or not. It is you the individual patient who needs to be advised of all the whys and why-nots in order to understand what treatment is being proposed. A major ethical principle is autonomy, and each and every one of you has the right to make your own decision as to treatment needs and who is best to provide them.

Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question? Email him at dr.richard@nothingbutthetooth.org.